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Reimbursement
Most public and private payers – such as Medicare, Medicaid, and managed care plans – will cover GAMMAGARD LIQUID therapy and GAMMAGARD S/D [Immune Globulin Intravenous (Human)] for labeled indications as approved by the U.S. Food and Drug Administration (FDA). Specific patient benefits, however, will vary among third-party payers.
Coverage
Most payers cover infusions of drugs and biologicals as part of their medical benefits, but some payers may require prior authorization (PA). To satisfy PA or medical necessity requirements for a particular patient, a payer may request the following types of information:
- Detailed information on the patient's medical condition and treatment history
- A statement or letter of medical necessity
- The product's Prescribing Information/ Package Insert
- The product's FDA approval letter
- The patient's weight
- The product's dosage
- The frequency of administration
Reimbursement
Payers have various reimbursement methodologies for infused drugs and biologicals. Payment systems will include the following:
- Based on published average wholesale prices (AWPs) as reported in various commercial services
- Per diem amounts
- Cost- or charge-based payment formulas
- Negotiated rates
- Contractual amounts
- Cost-based reimbursement
Please see the detailed Important Risk Information and Full Prescribing Information for GAMMAGARD LIQUID [Immune Globulin Intravenous (Human)] for full prescribing details.
Please see the detailed Important Risk Information and Full Prescribing Information for GAMMAGARD S/D [Immune Globulin Intravenous (Human)] for full prescribing details.
Please see the detailed Important Risk Information and Full Prescribing Information for GAMMAGARD S/D [Immune Globulin Intravenous (Human)], IgA less than 1 µg/mL in a 5% solution for full prescribing details.
